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For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"David Jones "},"financial_aid_policy":["In compliance with federal law and CMS regulation, North Caddo Hospital Service District is providing this list of our hospital facility standard charges in a computer readable format.  Charges for physicians and other qualified healthcare practitioners are not included. The charges are correct as of 4/1/2026.  The presence or absence of a charge does not indicate that the hospital does or does not provide a particular service.  Charges for individual patients will depend on many factors, including timed services, patient conditions, unexpected complications, and additional procedures, items, or services required.   North Caddo Hospital Service District does have a discounted cash pricing policy of 30% of billed charges if paid at time of service. To obtain more information about our financial assistance policy, if you have questions about charges, or would like to receive individualized price estimates, please contact the Business Office at 318-375-4017."],"standard_charge_information":[{"description":"57664-0229-88 - methylphenidate 10 mg 100 [CADDO]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"10013684","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664-0229-88","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"00409-2267-25 - labetalol mdv 5mg/ml 20ml 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Available","code_information":[{"code":"V5263","type":"LOCAL"}],"standard_charges":[{"setting":"both","billing_class":"facility","minimum":5000.0,"maximum":5000.0,"payers_information":[{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5000.0}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System With Mcc","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone marrow transplant","code_information":[{"code":"009","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"1 through 10","median_amount":2750.86,"10th_percentile":2750.86,"90th_percentile":2750.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"1 through 10","median_amount":42829.92,"10th_percentile":42829.92,"90th_percentile":42829.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"1 through 10","median_amount":6448.02,"10th_percentile":6448.02,"90th_percentile":6448.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"1 through 10","median_amount":2060.76,"10th_percentile":2060.76,"90th_percentile":2060.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"1 through 10","median_amount":24280.0,"10th_percentile":24280.0,"90th_percentile":24280.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"1 through 10","median_amount":8266.08,"10th_percentile":8266.08,"90th_percentile":35691.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"1 through 10","median_amount":5614.0,"10th_percentile":5614.0,"90th_percentile":5614.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"1 through 10","median_amount":11080.0,"10th_percentile":11080.0,"90th_percentile":11080.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"1 through 10","median_amount":5614.0,"10th_percentile":5614.0,"90th_percentile":5614.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"1 through 10","median_amount":2126.88,"10th_percentile":2126.88,"90th_percentile":2126.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"1 through 10","median_amount":9783.0,"10th_percentile":9783.0,"90th_percentile":9783.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"1 through 10","median_amount":2782.36,"10th_percentile":2782.36,"90th_percentile":2782.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"1 through 10","median_amount":5614.0,"10th_percentile":5614.0,"90th_percentile":5614.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"1 through 10","median_amount":13776.8,"10th_percentile":13776.8,"90th_percentile":13776.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"1 through 10","median_amount":11228.0,"10th_percentile":11228.0,"90th_percentile":11228.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"1 through 10","median_amount":404.94,"10th_percentile":404.94,"90th_percentile":404.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"1 through 10","median_amount":10772.0,"10th_percentile":10772.0,"90th_percentile":13785.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"1 through 10","median_amount":16518.36,"10th_percentile":16518.36,"90th_percentile":16518.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"1 through 10","median_amount":8623.3,"10th_percentile":8623.3,"90th_percentile":8623.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"1 through 10","median_amount":8054.32,"10th_percentile":8054.32,"90th_percentile":9342.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"1 through 10","median_amount":6679.18,"10th_percentile":6679.18,"90th_percentile":6679.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"1 through 10","median_amount":5385.08,"10th_percentile":5385.08,"90th_percentile":5385.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"1 through 10","median_amount":11228.0,"10th_percentile":11228.0,"90th_percentile":11228.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"1 through 10","median_amount":2784.46,"10th_percentile":2784.46,"90th_percentile":2784.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"1 through 10","median_amount":5386.0,"10th_percentile":5386.0,"90th_percentile":5386.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"1 through 10","median_amount":9958.0,"10th_percentile":9958.0,"90th_percentile":9958.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"1 through 10","median_amount":9783.0,"10th_percentile":9783.0,"90th_percentile":9783.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopy & Incisional Tubal Interruption","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"1 through 10","median_amount":13579.26,"10th_percentile":13579.26,"90th_percentile":13579.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"1 through 10","median_amount":3000.0,"10th_percentile":3000.0,"90th_percentile":3000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"1 through 10","median_amount":5614.0,"10th_percentile":5614.0,"90th_percentile":5614.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"1 through 10","median_amount":14000.0,"10th_percentile":14000.0,"90th_percentile":14000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/o CC/MCC","code_information":[{"code":"491","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Proc w Pdx Hemorrhage","code_information":[{"code":"528","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular shunt procedures w CC","code_information":[{"code":"529","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"1 through 10","median_amount":21414.96,"10th_percentile":21414.96,"90th_percentile":21414.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"1 through 10","median_amount":10522.57,"10th_percentile":10522.57,"90th_percentile":10522.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"1 through 10","median_amount":47588.8,"10th_percentile":47588.8,"90th_percentile":47588.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"1 through 10","median_amount":9453.64,"10th_percentile":9453.64,"90th_percentile":9453.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"1 through 10","median_amount":14272.37,"10th_percentile":14272.37,"90th_percentile":14272.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"1 through 10","median_amount":13785.8,"10th_percentile":13785.8,"90th_percentile":13785.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"1 through 10","median_amount":10772.0,"10th_percentile":10772.0,"90th_percentile":10772.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"1 through 10","median_amount":16276.55,"10th_percentile":16276.55,"90th_percentile":16276.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"1 through 10","median_amount":35691.6,"10th_percentile":35691.6,"90th_percentile":35691.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"1 through 10","median_amount":3000.0,"10th_percentile":3000.0,"90th_percentile":3000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures Without Cc/Mcc","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"1 through 10","median_amount":20444.11,"10th_percentile":20444.11,"90th_percentile":20444.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"1 through 10","median_amount":16996.0,"10th_percentile":16996.0,"90th_percentile":16996.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"1 through 10","median_amount":2807.0,"10th_percentile":2807.0,"90th_percentile":2807.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Admit For Renal Dialysis","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"1 through 10","median_amount":27000.0,"10th_percentile":27000.0,"90th_percentile":27000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"1 through 10","median_amount":11023.04,"10th_percentile":11023.04,"90th_percentile":11023.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"1 through 10","median_amount":11012.24,"10th_percentile":11012.24,"90th_percentile":11012.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"1 through 10","median_amount":3933.39,"10th_percentile":3933.39,"90th_percentile":3933.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W Cc/Mcc","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","code_information":[{"code":"692","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"1 through 10","median_amount":13317.9,"10th_percentile":13317.9,"90th_percentile":13317.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W Cc/Mcc","code_information":[{"code":"765","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W/O Cc/Mcc","code_information":[{"code":"766","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Sterilization &/Or D&C","code_information":[{"code":"767","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W/O Complicating Diagnoses","code_information":[{"code":"775","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Threatened Abortion","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"False Labor","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W Medical Complications","code_information":[{"code":"781","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W/O Medical Complications","code_information":[{"code":"782","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Cc","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. 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Procedures Without Cc/Mcc","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without 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period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"1 through 10","median_amount":1575.0,"10th_percentile":1575.0,"90th_percentile":1575.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"1 through 10","median_amount":9968.0,"10th_percentile":9968.0,"90th_percentile":9968.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"1 through 10","median_amount":10772.0,"10th_percentile":10772.0,"90th_percentile":10772.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"1 through 10","median_amount":6227.7,"10th_percentile":6227.7,"90th_percentile":6227.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"1 through 10","median_amount":31564.0,"10th_percentile":31564.0,"90th_percentile":31564.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","code_information":[{"code":"984","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","code_information":[{"code":"986","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3048] [Swing Bed-Per Diem: 2530] [IP High Cost Drugs (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":137.89,"10th_percentile":105.6,"90th_percentile":216.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":116.95,"10th_percentile":116.95,"90th_percentile":116.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":182.76,"10th_percentile":118.16,"90th_percentile":307.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"1 through 10","median_amount":162.4,"10th_percentile":118.32,"90th_percentile":183.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":134.16,"10th_percentile":118.32,"90th_percentile":210.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"165","median_amount":446.91,"10th_percentile":159.23,"90th_percentile":1062.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":404.73,"10th_percentile":263.05,"90th_percentile":523.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":549.0,"10th_percentile":549.0,"90th_percentile":550.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"85","median_amount":415.06,"10th_percentile":142.57,"90th_percentile":1264.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"118","median_amount":532.7,"10th_percentile":253.0,"90th_percentile":1747.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"43","median_amount":404.05,"10th_percentile":194.31,"90th_percentile":1378.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":582.92,"10th_percentile":582.92,"90th_percentile":1665.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"96","median_amount":1263.41,"10th_percentile":516.27,"90th_percentile":4103.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":4727.61,"10th_percentile":4727.61,"90th_percentile":4727.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":875.0,"10th_percentile":875.0,"90th_percentile":2200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"60","median_amount":1904.01,"10th_percentile":213.61,"90th_percentile":6766.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"49","median_amount":2108.95,"10th_percentile":514.9,"90th_percentile":5476.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"54","median_amount":1934.19,"10th_percentile":115.0,"90th_percentile":6686.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":27165.92,"10th_percentile":27165.92,"90th_percentile":27165.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"11","median_amount":1763.03,"10th_percentile":532.39,"90th_percentile":3705.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3343.46,"10th_percentile":3343.46,"90th_percentile":3343.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":875.0,"10th_percentile":875.0,"90th_percentile":875.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3757.03,"10th_percentile":107.8,"90th_percentile":8180.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"16","median_amount":3504.59,"10th_percentile":1470.74,"90th_percentile":6710.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"13","median_amount":117.65,"10th_percentile":110.0,"90th_percentile":4718.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":6733.67,"10th_percentile":6733.67,"90th_percentile":6733.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":456.97,"10th_percentile":456.97,"90th_percentile":593.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"1 through 10","median_amount":1007.05,"10th_percentile":871.35,"90th_percentile":1470.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":291.61,"10th_percentile":291.61,"90th_percentile":291.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":806.4,"10th_percentile":806.4,"90th_percentile":806.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":4326.69,"10th_percentile":4292.4,"90th_percentile":4530.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":315.0,"10th_percentile":315.0,"90th_percentile":315.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"1 through 10","median_amount":894.0,"10th_percentile":894.0,"90th_percentile":894.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":125.0,"10th_percentile":125.0,"90th_percentile":125.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"1 through 10","median_amount":436.56,"10th_percentile":436.56,"90th_percentile":436.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ENT Procedures","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":401.5,"10th_percentile":201.87,"90th_percentile":501.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"1 through 10","median_amount":405.0,"10th_percentile":405.0,"90th_percentile":405.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":317.72,"10th_percentile":317.72,"90th_percentile":317.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"1 through 10","median_amount":4203.28,"10th_percentile":3825.28,"90th_percentile":7272.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3875.51,"10th_percentile":3875.51,"90th_percentile":3875.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":3463.71,"10th_percentile":3463.71,"90th_percentile":3463.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":100.0,"10th_percentile":100.0,"90th_percentile":100.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1162.35,"10th_percentile":1162.35,"90th_percentile":1162.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":499.25,"10th_percentile":499.25,"90th_percentile":1397.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":966.65,"10th_percentile":966.65,"90th_percentile":966.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2062.24,"10th_percentile":2062.24,"90th_percentile":2062.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"1 through 10","median_amount":1135.71,"10th_percentile":1135.71,"90th_percentile":1135.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":2066.19,"10th_percentile":2066.19,"90th_percentile":2066.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1279.0,"10th_percentile":1279.0,"90th_percentile":1279.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1119.24,"10th_percentile":40.84,"90th_percentile":1129.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"1 through 10","median_amount":544.0,"10th_percentile":544.0,"90th_percentile":1145.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1132.46,"10th_percentile":1132.46,"90th_percentile":1132.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"1 through 10","median_amount":622.0,"10th_percentile":622.0,"90th_percentile":622.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":4521.46,"10th_percentile":4521.46,"90th_percentile":4521.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":4251.43,"10th_percentile":4251.43,"90th_percentile":5844.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"1 through 10","median_amount":2500.0,"10th_percentile":2500.0,"90th_percentile":2500.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3002.81,"10th_percentile":3002.81,"90th_percentile":3002.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":247.19,"10th_percentile":247.19,"90th_percentile":1094.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":1492.15,"10th_percentile":1440.23,"90th_percentile":1495.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1593.39,"10th_percentile":1593.39,"90th_percentile":1611.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"1 through 10","median_amount":405.0,"10th_percentile":405.0,"90th_percentile":405.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1637.99,"10th_percentile":1637.99,"90th_percentile":1637.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":952.52,"10th_percentile":952.52,"90th_percentile":952.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1611.51,"10th_percentile":1611.51,"90th_percentile":1611.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"1 through 10","median_amount":607.5,"10th_percentile":405.0,"90th_percentile":708.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1634.93,"10th_percentile":1634.93,"90th_percentile":1634.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"67","median_amount":85.85,"10th_percentile":71.77,"90th_percentile":634.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":115.95,"10th_percentile":115.95,"90th_percentile":115.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":160.68,"10th_percentile":160.68,"90th_percentile":522.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"64","median_amount":103.38,"10th_percentile":71.33,"90th_percentile":219.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"57","median_amount":144.2,"10th_percentile":133.7,"90th_percentile":324.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"37","median_amount":105.06,"10th_percentile":91.8,"90th_percentile":310.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":103.27,"10th_percentile":103.27,"90th_percentile":103.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"105","median_amount":180.78,"10th_percentile":76.55,"90th_percentile":365.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":244.9,"10th_percentile":116.43,"90th_percentile":1040.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":341.64,"10th_percentile":341.64,"90th_percentile":341.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"98","median_amount":193.63,"10th_percentile":74.38,"90th_percentile":324.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"91","median_amount":307.3,"10th_percentile":162.4,"90th_percentile":566.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"53","median_amount":236.64,"10th_percentile":107.1,"90th_percentile":767.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":731.81,"10th_percentile":255.22,"90th_percentile":736.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"39","median_amount":718.65,"10th_percentile":372.34,"90th_percentile":1060.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":978.11,"10th_percentile":978.11,"90th_percentile":1627.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":361.92,"10th_percentile":361.92,"90th_percentile":361.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"30","median_amount":931.63,"10th_percentile":235.31,"90th_percentile":1634.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"28","median_amount":1369.9,"10th_percentile":1297.8,"90th_percentile":2514.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"18","median_amount":978.5,"10th_percentile":446.76,"90th_percentile":1661.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":973.29,"10th_percentile":973.29,"90th_percentile":973.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":1358.81,"10th_percentile":1263.91,"90th_percentile":1408.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":777.79,"10th_percentile":777.79,"90th_percentile":777.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":780.59,"10th_percentile":780.37,"90th_percentile":1612.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"1 through 10","median_amount":1088.5,"10th_percentile":1088.5,"90th_percentile":1088.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":793.05,"10th_percentile":777.5,"90th_percentile":793.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":660.86,"10th_percentile":263.92,"90th_percentile":1384.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2975.93,"10th_percentile":2975.93,"90th_percentile":2975.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"1 through 10","median_amount":1509.2,"10th_percentile":1460.2,"90th_percentile":5611.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1204.62,"10th_percentile":1204.62,"90th_percentile":1204.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"44","median_amount":1162.16,"10th_percentile":605.68,"90th_percentile":1652.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1974.22,"10th_percentile":1924.74,"90th_percentile":3180.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"23","median_amount":2688.7,"10th_percentile":2127.3,"90th_percentile":3670.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2496.45,"10th_percentile":1641.69,"90th_percentile":2816.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":4095.88,"10th_percentile":2804.98,"90th_percentile":6418.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"11","median_amount":3710.37,"10th_percentile":167.36,"90th_percentile":6856.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"1 through 10","median_amount":5956.75,"10th_percentile":5213.17,"90th_percentile":19113.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":5963.42,"10th_percentile":2300.59,"90th_percentile":19003.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"17","median_amount":1056.81,"10th_percentile":256.11,"90th_percentile":3174.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":3944.84,"10th_percentile":807.13,"90th_percentile":16215.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"1 through 10","median_amount":211.4,"10th_percentile":196.51,"90th_percentile":1724.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1025.22,"10th_percentile":744.21,"90th_percentile":6726.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":225.33,"10th_percentile":185.97,"90th_percentile":856.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":483.16,"10th_percentile":238.38,"90th_percentile":538.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"1 through 10","median_amount":332.5,"10th_percentile":332.5,"90th_percentile":2750.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":242.25,"10th_percentile":242.25,"90th_percentile":465.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":234.66,"10th_percentile":234.66,"90th_percentile":234.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"149","median_amount":1385.82,"10th_percentile":731.85,"90th_percentile":1732.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1345.46,"10th_percentile":1310.09,"90th_percentile":1351.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":2109.12,"10th_percentile":2099.76,"90th_percentile":2109.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"45","median_amount":1350.96,"10th_percentile":297.01,"90th_percentile":1356.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"131","median_amount":1884.4,"10th_percentile":1352.0,"90th_percentile":1892.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"42","median_amount":1372.92,"10th_percentile":1352.0,"90th_percentile":1379.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1315.69,"10th_percentile":1315.69,"90th_percentile":1315.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":978.37,"10th_percentile":628.18,"90th_percentile":4463.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":2199.1,"10th_percentile":1174.5,"90th_percentile":4929.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"18","median_amount":2540.04,"10th_percentile":605.0,"90th_percentile":6941.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":176.06,"10th_percentile":176.06,"90th_percentile":176.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":1374.44,"10th_percentile":1374.44,"90th_percentile":1374.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":115.43,"10th_percentile":115.43,"90th_percentile":115.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"1 through 10","median_amount":476.7,"10th_percentile":476.7,"90th_percentile":476.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":194.17,"10th_percentile":194.17,"90th_percentile":194.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":323.38,"10th_percentile":322.5,"90th_percentile":323.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"1 through 10","median_amount":451.5,"10th_percentile":451.5,"90th_percentile":612.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":328.95,"10th_percentile":328.95,"90th_percentile":328.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":403.3,"10th_percentile":403.3,"90th_percentile":403.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":229.69,"10th_percentile":229.69,"90th_percentile":229.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"1 through 10","median_amount":556.82,"10th_percentile":556.82,"90th_percentile":556.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventilation Initiation and Management","code_information":[{"code":"5801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":4141.59,"10th_percentile":4141.59,"90th_percentile":4141.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"RBC leukocytes reduced","code_information":[{"code":"9512","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":4292.29,"10th_percentile":4292.29,"90th_percentile":4292.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"54","median_amount":105.74,"10th_percentile":38.02,"90th_percentile":293.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":410.33,"10th_percentile":410.33,"90th_percentile":410.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":419.64,"10th_percentile":419.64,"90th_percentile":419.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"43","median_amount":176.96,"10th_percentile":57.91,"90th_percentile":372.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"94","median_amount":273.0,"10th_percentile":80.5,"90th_percentile":711.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"49","median_amount":146.0,"10th_percentile":84.66,"90th_percentile":353.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":319.32,"10th_percentile":254.51,"90th_percentile":329.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"112","median_amount":677.95,"10th_percentile":182.35,"90th_percentile":2364.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":272.38,"10th_percentile":263.79,"90th_percentile":1080.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"1 through 10","median_amount":438.97,"10th_percentile":438.97,"90th_percentile":438.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":1275.0,"10th_percentile":1275.0,"90th_percentile":1275.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"58","median_amount":404.01,"10th_percentile":112.5,"90th_percentile":1532.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"82","median_amount":280.0,"10th_percentile":70.0,"90th_percentile":840.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"28","median_amount":701.25,"10th_percentile":300.0,"90th_percentile":1200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":880.72,"10th_percentile":150.0,"90th_percentile":1007.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"78","median_amount":182.98,"10th_percentile":164.16,"90th_percentile":182.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"1 through 10","median_amount":143.94,"10th_percentile":143.94,"90th_percentile":143.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [ED Level 1--99281 ($): Fee Schedule] [ED Level 2--99282 ($): Fee Schedule] [ED Level 3--99283 ($): Fee Schedule] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Occupational Therapy Fee Schedule: Fee Schedule] [Physical Therapy Fee Schedule: Fee Schedule] [Resp. Services/Therapy Fee Schedule: Fee Schedule] [Speech Therapy Fee Schedule: Fee Schedule] [IV Therapy ($): Fee Schedule] [Pulmonary Function ($): Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surgery (%BC): 73 Maximum Reimbursement: 3250] [Cardiac Cath (%BC): 78] [Observation ($): 1200] [Emergency Department (%BC): 78 Maximum Reimbursement: 875] [ED Level 1--99281 ($): 300] [ED Level 2--99282 ($): 300] [ED Level 3--99283 ($): 550] [Chemotherapy (%BC): 78] [Nuclear Medicine (%BC): 78] [Radiation Therapy (%BC): 78] [CT Scan OP ($): 850] [MRI OP ($): 925] [Positron Emission Tomography ($): 2500] [Radiology (%BC): 78] [Laboratory (%BC): 78] [Hemodialysis (%BC): 78] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 85] [Physical Therapy ($): 85] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 85] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":224.64,"10th_percentile":224.64,"90th_percentile":224.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EMG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Positron Emission Tomography (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"18","median_amount":143.95,"10th_percentile":143.95,"90th_percentile":143.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: Fee Schedule]","count":"41","median_amount":201.6,"10th_percentile":201.6,"90th_percentile":201.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [All Other OP (%BC): 56]","count":"24","median_amount":77.39,"10th_percentile":77.39,"90th_percentile":77.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 56] [Observation (%BC): 56] [Emergency Department (%BC): 56] [EEG (%BC): 56] [Sleep Studies (%BC): 56] [CT OP Scan (%BC): 56] [MRI OP (%BC): 56] [Imaging Services (%BC): 56] [Mammography-Diagnostic (%BC): 56] [Mammography-Screening (%BC): 56] [Radiology (%BC): 56] [Laboratory (%BC): 56] [Occupational Therapy (%BC): 56] [Physical Therapy (%BC): 56] [Respiratory Services/Therapy (%BC): 56] [Speech Therapy (%BC): 56] [OP High Cost Drugs (%BC): 56] [Ambulance--Land (%BC): 56] [IV Therapy (%BC): 56] [Pulmonary Rehabilitation (%BC): 56] [All Other OP (%BC): 56]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]}],"modifier_information":[{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Bcbs","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Bcbs","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Bcbs","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Bcbs","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Bcbs","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."}]},{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Bcbs","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."}]},{"description":"Clia waived test","code":"QW","modifier_payer_information":[{"payer_name":"Bcbs","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Bcbs","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."}]},{"description":"Catastrophe/disaster related","code":"CR","modifier_payer_information":[{"payer_name":"Bcbs","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."}]},{"description":"Physician providing a service in an unlisted health professional shortage area (hpsa)","code":"AQ","modifier_payer_information":[{"payer_name":"Bcbs","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."}]},{"description":"Ambulance service furnished directly by a provider of services","code":"QN","modifier_payer_information":[{"payer_name":"Bcbs","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peoples Health","plan_name":"Managed Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Health Plan","plan_name":"Managed Medicare Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Hmo Blue Texas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."}]}]}